TITLE: Better Efficacy of Balloon Assisted Maturation in Radial-Cephalic Arteriovenous Fistula for Hemodialysis.

Purpose: Native arteriovenous fistula (AVF) is the first choice for hemodialysis access; however, the maturation failure rate remains high. Hence, balloon-assisted maturation (BAM) is increasingly being used to overcome maturation failure. This study evaluated the outcomes of BAM and compared the differences between radial-cephalic (RC) and brachial-cephalic (BC) AVF.

Materials and Methods: Between January 2013 and December 2017, 1,622 new AVFs were created. BAM was considered if the AVF did not satisfy the criteria for hemodynamic maturation (6-mm diameter and 500-mL/min flow rate within 8 weeks after the operation).

Results: Of the 1,622 AVFs, BAM was performed in 142 patients (8.75%). There were 92 RC and 50 BC AVFs. Multivariate analyses revealed that ipsilateral central vein catheter history was the sole risk factor for maturation failure after BAM. One-year functional primary patency (FPP) and functional secondary patency (FSP) in RC AVFs were higher than those in BC AVFs without statistical significance (FPP, RC vs. BC: 70.9% vs. 50.9%, P=0.099; FSP, 95.5% vs. 81.1%, P=0.146). Further, based on the multivariate analysis, the independent risk factors for FPP in the RC and BC AVFs were the number of BAMs (odds ratio [OR], 3.05; 95% confidence interval [CI], 1.11-8.37; P=0.03) and age (OR, 1.04; 95% CI, 1.00-1.07; P=0.04), respectively.

Conclusion: BAM is a relatively good salvage method with tolerable patency. However, the risk factors for patency and the outcomes of BAM differ between RC and BC AVFs.

SOURCE:  Kim HK, Han A, Ahn S, et al. Better Efficacy of Balloon Assisted Maturation in Radial-Cephalic Arteriovenous Fistula for Hemodialysis[J]. Vasc Specialist Int, 2021, 37(1):29-36. DOI: 10.5758/vsi.210003.

目的：动静脉内瘘（AVF）是血液透析通路的首选；但是，成熟失败率仍然很高。因此，越来越多地使用球囊辅助促成熟（BAM）来克服成熟失败的问题。这项研究评估了BAM的结局，并比较了桡头型（RC）和肱头型（BC）AVF的差异。

材料和方法：2013年1月至2017年12月之间，建立了1,622个新的AVF。如果AVF不满足血流动力学成熟的标准（手术后8周内直径为6 mm，流速为500 mL / min），则考虑采用BAM。

结果：在1,622例AVF中，有142例患者（8.75％）进行了BAM。有92个RC和50个BC AVF。多变量分析显示，同侧中心静脉导管史是BAM后成熟失败的唯一危险因素。 RC AVFs的一年功能性一期通畅性（FPP）和功能性二期通畅性（FSP）高于BC AVFs，但无统计学差异（FPP，RC vs. BC：70.9％vs. 50.9％，P = 0.099; FSP，95.5％对比81.1％，P = 0.146）。此外，基于多变量分析，RC和BC AVF中FPP的独立危险因素是BAM的数量（优势比[OR]为3.05； 95％置信区间[CI]为1.11-8.37；P = 0.03）和年龄（OR，1.04； 95％CI，1.00-1.07； P = 0.04）。

结论：BAM是一种相对较好的挽救方法，其通畅性可以接受。但是，RC和BC AVF之间通畅的风险因素和BAM的结果有所不同。

启发：球囊促成熟可以挽救成熟不良的内瘘，但仍有许多内容尚不确定，比如应用多大的球囊，最早什么时候可以干预，什么样的因素造成的成熟不良对球囊更有效？等等。